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Blood Pressure Checks at Home Lauded

June 14, 2010
denver and the west Blood pressure checks at home lauded By Jennifer Brown The Denver Post Posted: 05/31/2010 01:00:00 AM MDT Nathalie Cole checks her blood pressure Thursday at her home in Golden. She says that being able to check more often helped her to change her diet, along with keeping her medications up to date. ( Diego James Robles, The Denver Post )A study involving 348 Colorado patients with hypertension could change the way doctors monitor patients with high blood pressure, diabetes and perhaps a host of other diseases. The study patients were randomly split into two groups — half were sent home with blood-pressure cuffs that could download readings online, while the other half stuck to monthly or so doctors' appointments to get checked. The difference in outcomes was significant. At the end of six months, 38 percent of the patients who visited doctors had their hypertension under control. But 58 percent of the patients submitting their readings online almost daily had their blood pressure under control. "People get excited about a 2- or 3-percent difference in blood-pressure control," said Dr. David Magid, lead investigator for the Kaiser Permanente Colorado study and an emergency physician at St. Joseph Hospital. "A 20 (percentage point) difference is huge." Put another way, patients in the home-monitoring group were about 50 percent more likely than the other group to have their blood pressure under control. The positive outcome was much more pronounced than in previous studies about how changes in diet and exercise improve hypertension, Magid said. But diet and exercise did play a role in this study. Nathalie Cole used to find out about her blood pressure in her doctor's office. After six months, taking her blood pressure at home about four times per week, the Golden woman became her own expert. Cole knew when she was eating too much sodium-laden processed food. She wasn't surprised when, through readings on the computer, her doctor's office changed her medication. In the end, Cole's blood pressure was within normal range. "I've changed my diet a lot since all of this," she said. "More fresh stuff, less salt. The only thing I even salt anymore is meat, and that's very rare." In touch with the body Even though her part in the study is over, Cole, 44, has the blood-pressure cuff to download readings into her computer. Mostly, she wants to know whether the stress of two jobs and her father's recent death is causing her numbers to spike. The readings take less than 10 minutes to record and send online, and she doesn't have to write anything down. The electronic cuff stores several readings, then uses a cord similar to the one on a digital camera to send them via the Internet to her doctors. A clinician at her doctor's office reviews the numbers and lets her know whether she needs a new prescription. Kaiser partnered with Microsoft to develop the technology for the research. As many as 73 million Americans have high blood pressure, which can lead to heart disease, heart attack, stroke and kidney disease. But it is often difficult to control because patients don't necessarily feel symptoms and don't see a doctor. National data shows that only about one-third of people with hypertension receive treatment and have it under control. Dr. Larry Hergott, director of general cardiology at the University of Colorado medical school, called the results "phenomenal." He was not part of the study. Controlling hypertension reduces the risk of a heart attack by 25 percent and stroke by 40 percent, he said. It makes sense for patients to take their own blood pressure at home because anxiety about being on an exam table often causes higher readings, he said. Hergott noted the study is based on a specific population, people who have insurance and can afford a computer. Impact of doctor visits Before the study, Kaiser doctors learned from patients who attended focus groups that it wasn't the price of medications keeping them from controlling blood pressure, it was the annoyance of having to go to the doctor every few weeks. "They have to take off a fair bit of time from busy lives, from work, go to the doctor, go to the pharmacy," Magid said. "They are willing to do that once or twice, but sometimes it takes quite a while, multiple medicines and multiple dose changes. We thought maybe it would be better to have a self-management approach," he said. Magid said he is hopeful that the whole Kaiser system, and others, will begin to use home- monitoring systems for hypertension patients. Diabetics could use a similar system by pricking their finger and downloading glucose levels online, Magid said. "When you involve patients in their care, then I think they are more committed to taking care of their disease," Magid said. Kaiser researchers recently presented their findings at the American Heart Association's forum on cardiovascular disease and stroke. Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com